Provider Demographics
NPI:1942770755
Name:JARVIS, MADISON CHRISTINA (LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:CHRISTINA
Last Name:JARVIS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:MS
Other - First Name:MADISON
Other - Middle Name:CHRISTINA
Other - Last Name:LOCKABY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:6300 HOSPITAL PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1983
Mailing Address - Country:US
Mailing Address - Phone:678-205-4261
Mailing Address - Fax:
Practice Address - Street 1:6300 HOSPITAL PKWY STE 400
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1983
Practice Address - Country:US
Practice Address - Phone:678-205-4261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0030712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer